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Pawel Hertz писал(а): ↑

Чт сен 20, 2018 7:12 pm

What kind of examination take you in patients with LE of not known origin: 1. patients over 75 2. Patients between 50-75 and 3. under 50 4. younger. Mine have large lymph nodes up to 1,5cm in trachea region! Does it malignancy / sarcoidose / inflamation ?? What are yours experiences ?

Do you mean targeted diagnostics to reveal some age-specific diseases?
May be, in youngsters preferable tools are EBV DNA analysis, HIV, tuberculin skin test,
Under 50 - serum angiotensin converting enzyme, calcium, AFP, hCG,
Between 50 and 75 - bronchoscopy, EBV, US of supraclavicular areas,
Above 75 - esophagoscopy, squamous cell carcinoma antigen.
Most of the other relevant cancers are already excluded by CT and US.

Do you mean targeted diagnostics to reveal some age-specific diseases?
May be, in youngsters preferable tools are EBV DNA analysis, HIV, tuberculin skin test,
Under 50 - serum angiotensin converting enzyme, calcium, AFP, hCG,
Between 50 and 75 - bronchoscopy, EBV, US of supraclavicular areas,
Above 75 - esophagoscopy, squamous cell carcinoma antigen.
Most of other relevant cancers are already excluded by CT and US.
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Interesting. Thank you. Valuable advice. What with supraclavicular areas ? I haven't thougth HIV and tbc

Pawel Hertz писал(а): ↑

Пт сен 21, 2018 10:30 pm

Do you mean targeted diagnostics to reveal some age-specific diseases?
May be, in youngsters preferable tools are EBV DNA analysis, HIV, tuberculin skin test,
Under 50 - serum angiotensin converting enzyme, calcium, AFP, hCG,
Between 50 and 75 - bronchoscopy, EBV, US of supraclavicular areas,
Above 75 - esophagoscopy, squamous cell carcinoma antigen.
Most of other relevant cancers are already excluded by CT and US.

Interesting. Thank you. Valuable advice. What with supraclavicular areas ? I haven't thougth HIV and tbc
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I thought you were testing us, our knowledge of age-related pathology, and so gave my own answer:
to check EBV - in order to rule out Hodgkin's lymphoma and Burkitt's lymphoma;
serum angiotensin converting enzyme (SACE) and serum calcium - sarcoidosis;
AFP and hCG - testicular tumor;
bronchoscopy - bronchial tumor;
esophagoscopy - esophageal cancer;
squamous cell carcinoma antigen (SCCA) - rectal cancer;
I suggested US of supraclavicular areas, because there is some information in the literature about such meta, if primary tumor is thymoma.
Thyroid cancer was ruled out with UL, abdominal and renal tumors - by CT. Melanocarcinoma could be visualized at physical examination. Any other malignancies with meta in mediastinum are unknown to me. Rely upon more informed colleagues

And what about fIbrosing mediastinitis?
For example, due to fungal infection:
Histoplasmosis

https://www.ncbi.nlm.nih.gov/pubmed/29946500

(urine histoplasma antigen is suggestive as a noninvasive diagnostic tool)
Aspergillosis
https://www.ncbi.nlm.nih.gov/pubmed/24998315
(serum Aspergillus galactomannan antigen is suggestive)